SP Premium
LITTLEWIND53
200,000-249,999 SparkPoints 237,707
SparkPoints
 

Application to be Sick

Sunday, May 25, 2014

Province of ______________________________
(note: Left blank to protect the guilty)
MINISTRY OF HEALTH
MENTAL HEALTH ACT

Application to be Sick

This form must be submitted at least 21 days before the date on which you wish illness to commence.

NAME ______________________________
________

EMPLOYEE NUMBER ___________________________

DEPARTMENT ______________________________
__

POSITION ______________________________
_____

NATURE OF ILLNESS _________________________

DATE ON WHICH YOU WISH ILLNESS TO COMMENCE _____________
(Applications to suffer from Pregnancy must be submitted 12 months prior and be accompanied for form /36/24/98)
Consent of Husband/Wife: ________________________

HAVE YOU EVER APPLIED TO SUFFER FROM THIS ILLNESS BEFORE _____

IF SO, GIVE DATE(S) ______________________________
_

DO YOU WISH ILLNESS TO BE SLIGHT/SEVERE/CRIPPLING/FATAL ______

IF ILLNESS IS FATAL, DO YOU WISH IT TO BE CONSIDERED A PERMANENT DISABILITY ______________________________
_________
(Applicants wishing to suffer a fatal illness should indicate at the bottom of form whether they wish their co-workers and/or Board of Directors to be present at the funeral/cremation)

DO YOU WISH TO SUFFER THIS ILLNESS AT HOME/HOSPITAL/HAWAII/BANFF/VAN
COUVER/ETC_______________

DO YOU WISH THIS ILLNESS TO BE CONTAGIOUS ________________

IF SO, APPROXIMATE THE NUMBER OF PEOPLE YOU WISH TO INFECT _____

HAVE YOU EVER BEEN REFUSED PERMISSION TO SUFFER FROM AN ILLNESS ______________________________
____________________

IF SO, GIVE DETAILS ______________________________
_______

DO YOU WISH YOUR SPOUSE TO BE INFORMED OF YOUR ILLNESS IF THEY CONTACT THE COMPANY REGARDING YOUR WHEREABOUTS _________________________


I, the undersigned, declare that to the best of my knowledge, the answers given above are true and accurate

SIGNED _________________________ DATE _______________________

(Applicants are reminded that all applications will be considered on merit and that more than three applications per annum will be considered excessive, and not in the best interest of the company. Under NO CIRCUMSATANCES will any employee be permitted to suffer more than one fatal illness.

MHLTH 3123
Rev: 91/12

(I found this in a pile of papers and thought it was so funny. Source is unknown.)
Share This Post With Others
Member Comments About This Blog Post
  • MOMMA_BEAR_69
    Sounds like a form that many should be filing out...UNBELIEVABLE!!!
    Blessings and hugs,
    Helen
    2063 days ago
  • USMAWIFE
    I know people who would always be filling that out
    2063 days ago
  • 1CRAZYDOG
    OMG! That's it! OMG No common sense to things, sometimes! It's the same here in the States.
    2064 days ago
  • LADYWYNDY
    Sounds about right emoticon
    2064 days ago
  • Add Your Comment to the Blog Post

    Log in to post a comment


    Disclaimer: Weight loss results will vary from person to person. No individual result should be seen as a typical result of following the SparkPeople program.